Gay Men's Mental Health
By Chris Banks
Introduction
Homophobia and heterosexism
Help services
Tips for wellness
Conclusion
Introduction
Although it may seem extraordinary now, being a gay man has been illegal in New Zealand for most of the last 100 years. Homosexuality itself was pathologised as a mental illness by the American Psychiatric Association until 1973, a classification that reflected on clinical practice and mental health services in New Zealand as well.
Eventually it came to be recognised that sexual orientation itself was a red herring when it came to the cause of mental illness among gay men. In fact, it was the experience of living in a society where gay men being open about their sexuality could expect rejection at best, and violence at worst, that led to mental ill health - although there are some researchers and clinicians who believe the jury is still out over whether those with same-sex attraction are predisposed in some way toward mental illness. This in itself has led to major issues with how gay men are treated within mental health services, as we shall see.
Legislative change in New Zealand throughout the 1980s, 1990s and 2000s worked to alleviate the effects of societal prejudice at an institutional level but, like racism, homophobia has yet to be fully addressed.
Research by Professor David Fergusson at Otago University's Christchurch School of Medicine, published in 2005, found young gay men experienced mental health problems five times more often than young straight men. Being gay was associated with increasing rates of depression, anxiety, illicit drug dependence, suicidal thoughts and suicide bids.
In the UK, gay and bisexual men are over four times more likely to attempt suicide than straight men - an astonishing statistic when you consider that men in general are already at heightened risk of suicide.
So what are some of the sources of mental distress for gay men?
Homophobia and heterosexism
UK gay advocacy organisation Stonewall defines homophobia as "the irrational hatred, intolerance and fear of LGB (lesbian, gay, bisexual) people." It defines heterosexism as "bias shown by a society or community where cultural institutions and individuals are conditioned to expect everyone to live and behave as heterosexuals."
These twin poles of prejudice work to fuel internalised stigma, resulting in damage to self-esteem, self-image, and potentially self-hatred. Ironically, the prejudice experienced by gay men comes from much the same sources as for those experiencing mental illness: family, workmates and messages received from society at large, including medical professionals.
Gay men can potentially feel doubly disenfranchised from society with their feelings for members of their own sex derided or making them victims of bullying or violence, and denied from claiming their male identity by participating in many typically male pursuits - gay men are not considered by many in society to be "real" men.
A recent example of the embodiment of this attitude were statements made by Irish pop star Brian McFadden on Auckland radio station More FM during a guest appearance in August 2008. During a discussion about whether men should wear pink, McFadden retorted: "Saying pink is a form of red is the same as saying homosexual is a form of male."
His remarks and the subsequent protests from gay groups made headlines around the world, yet the station's owners, MediaWorks, have resolutely refused to respond to calls for an apology.
Identity crises are also experienced by gay men from ethnic minorities, some of whom feel forced to choose between their cultural and sexual identity because of homophobia. Coping with racism and homophobia from society at large puts immense strain on gay men from ethnic minorities.
The spectre of HIV and AIDS also adds an extra layer of pressure for gay men to bear. While drug treatments have staved off the grisly deaths that decimated communities of gay men in the 1980s and 1990s, gay men are 40 times more likely to be HIV positive than heterosexuals in New Zealand. The prejudice and ignorance associated with HIV, including a ‘blame' mentality for who is responsible for causing the epidemic, spills over onto those who are HIV negative.
In recognition of the role that internalised stigma plays on whether men choose to engage in safe sex, HIV and gay advocacy organisations have tasked themselves with countering stigma and discrimination as well as promoting condom use, in addition to gay men's mental health and substance abuse.
Help available
Sexual health and identity issues
The New Zealand AIDS Foundation provides counselling and therapy for gay and bisexual men through its Positive Health service in Auckland, Wellington and Christchurch.
Areas covered in counselling and therapy include living with HIV or AIDS, both as an individual and as part of a larger support network that may include a partner, family and/or friends; issues relating to gender or sexual identity and associated behaviours; grief, relationships, treatment-related issues and promoting adherence to any needed medications, reinforcing safe sexual behaviours and supporting healthy approaches to life.
The AIDS Foundation has provided these services since its inception in the mid-1980s, and feels it is important to provide them because of the specialised skill involved in relation to sexual health issues.
"We provide safe, comfortable, confidential environments with fully trained professional counsellors and psychotherapists who are comfortable talking about sexuality and sexual practices in a respectful, compassionate, sex-positive way," AIDS Foundation national positive health manager Eamonn Smythe says.
"These services are free and completely confidential, and have a range of different people available to talk with clients, male and female, straight and gay, so the client can find someone who they can relate to, thus enhancing the therapeutic relationship."
People living with HIV outside the main centres can access a satellite service run by the AIDS Foundation in Dunedin, Greymouth, Palmerston North, Wanganui, Napier, Rotorua, Whangarei with plans for more regions to be added in the coming year.
Waiting times vary depending on the location and the service being requested, Smythe says, but in most cases clients will be seen for an initial meeting within a week.
Substance abuse issues
Although little data is available with regards to sexual orientation and drug/alcohol abuse, the data we do have show that it is far more prevalent among gay and bisexual men than among the population at large.
In Auckland, the Community Alcohol and Drug Services (CADS) provides free alcohol and drug counselling for gay men, with dedicated staff, including a youth service for those under 19 years old.
Vicky Clothier is one of the dedicated clinicians, working in a regional position that covers five CADS units across Auckland. She also runs a community clinic at the New Zealand Prostitutes' Collective, where many of her clients are transgender or men who have sex with men.
"All our units offer daily drop-in clinics from 10am - 1pm, where people don't need an appointment to have a brief alcohol and drug assessment," she explains. "At this initial contact they will be offered a range of different counselling options. Clients have the option of seeing a designated specialist clinician or any of our mainstream clinicians, who all have had affirming sexuality training."
The designated positions were first established in the late 1990s, initially funded out of HIV prevention budgets.
"We don't collect stats around people's sexuality, so are unable to give you an estimate of how well our service is accessed by gay and bisexual men, though I can say I am very busy and stats indicate that I have provided 600 individual counselling sessions over the past year to clients requesting a designated service."
Gay and bisexual service users
Given the higher prevalence of mental health problems among gay men compared to heterosexual men, what issues do gay and bisexual service users face?
David Semp, a clinical psychologist and gay man, explored some of these in a 2006 PhD thesis entitled: A Public Silence, referring to the invisibility of gay, lesbian, bisexual and transgender people and issues within public mental health services, and the dearth of discussion and literature available on the subject.
In a series of qualitative interviews with both gay staff and consumers of mental health services, Semp concluded that both groups were "subject to multiple, and often contradictory, discourses, which work to produce and constrain conversations about homosexuality in PMHS (primary mental health services)."
Gay staff were disinclined to raise sexuality as an issue for various reasons, including offending heterosexual clients or, if the client is gay but in denial, upsetting them while they are in a 'fragile' state. With regards to youth service users, fear of upsetting parents was an issue, even if homosexuality was raised indirectly.
"One child and adolescent mental health service declined to participate in this research because of this issue," Semp writes. "The reason was that relationships between mental health staff and parents are fraught enough already; having queer brochures in the waiting room was considered likely to hinder those relationships even more."
The prevalent philosophy is to leave it up to the client to decide if he wishes to raise sexuality as an issue. Semp's interviews discovered that this approach was fraught with difficulties. Firstly, it leads some services to believe that they have no gay clients, something that sits clearly at odds with statistics about homosexuality and mental health.
Secondly, the silence has a damaging effect on gay service users, who take it to mean that homosexuality is a taboo subject. One man interviewed in Semp's writings, a client of mental health services for over 10 years, only worked up the courage to disclose his sexuality in a suicide note. He survived his suicide attempt, only to find his sexuality was still not discussed by clinical staff.
Another example involved a young man referred to mental health services following a suicide attempt that he related to concerns about his sexuality and HIV.
"He experienced PMHS as a place that was not at all interested in his sexuality and consequently he refused to have further contact with them," Semp writes. "Fortunately, his GP told him about a specialist lesbian and gay affirmative counselling service where he reported getting the support he needed."
These two examples illustrate a third difficulty with placing the onus of disclosure on the client, Semp theorised: the types of clients who use primary mental health services are more likely to see their sexuality as something private, which should be hidden, an attitude reinforced by homophobia prevalent in society and historically within the mental health service itself.
In recognition of this, Semp collects recommendations for change from various pieces of research which should improve mental health services for gay men. These include:
- making the physical environment affirmative by including acknowledgement of gay, lesbian, bisexual and transgender (GLBT) identities in pamphlets, posters and forms
- ensuring that GLBT people are not pathologised or ignored
- supporting GLBT people to explore their sexual orientation
- staff should be aware of GLBT issues
- staff should be aware of how to respond appropriately to GLBT people.
Services made available by CADS and the New Zealand AIDS Foundation have already put such policies into practice. For those who haven't, Semp argues that this works against recovery from serious mental health problems for some clients, and goes against some aspects of national mental health policy, such as understanding the impact of stigma and discrimination and, in the words of Mary O'Hagan, demonstrating "the ability to adopt the storyteller's frame of reference".
Download David Semp's full research paper.
Tips for wellness
But what are the factors affecting wellness for gay men?
The National Lesbian and Gay Health Association in the United States has been in operation since the late 1970s and comprises health professionals, educators, researchers, primary-care clinics and advocates. In 1997, it published The Gay Men's Wellness Guide by Robert E. Penn, a 600-page manual dedicated to comprehensively addressing issues affecting gay men at all life stages and from varying backgrounds. Issues covered in the book range from mental and physical health to sexual attraction and behaviour.
A recurring theme in the book is the importance of self-acceptance.
"Your first step toward wellness is self-acceptance. At the very least, this means you will have to come out to yourself. Mental-health or other health-care providers might help you in this often arduous task. Friends are almost always essential to the process, especially openly lesbian, gay, bisexual, and transgender friends or acquaintances. It's easier when you're not alone."
Reaching out to others is also seen as incredibly important.
"As the gay son, you were encouraged to grow in every other aspect of your life except the one that promises to provide the greatest emotional fulfilment. Gay expression for the gay man is life. It opens the way to deep connection, romance, and well-rounded intimacy.
"The most important accomplishment any individual can achieve is to have a full, rich life. This includes taking care of your physical and emotional lives. For the gay male, taking care of yourself means living openly, breaking the isolation, overcoming the secret shame of sexual orientation, and embracing sexuality."
Also important is overcoming barriers to intimacy that gay men experience by internalising homophobia and messages from society about how men are supposed to behave and interact with each other. Ways in which intimacy can be introduced into relationships include looking friends in the eye, encouraging non-erotic physical closeness, and communicating your feelings: letting friends know when you are concerned about them, want to see them, or miss them.
"You may have thought that intimacy requires loss of power. Or you may fear that... becoming feminine or giving up power are the worst fates possible... Intimate relationships, whether romantic or not, increase power. Intimacy - the act of opening up to someone you like - improves your self-image. It is possible to see how flexible, sensitive, responsive, intelligent, intuitive and more capable you are in the context of intimate interactions with friends, family and lovers."
Conclusion
In New Zealand, there are many who believe that because the battle for equal rights in a legislative sense have been more or less won, issues for gay men have vanished along with them.
Some are afraid to look for these issues, some ignore them, and some simply don't see. There is a well-meaning fear, particularly within mental health, of 're-pathologising' homosexuality by not recognising the problems that gay men as a minority face.
It seems clear that, as with poorer health outcomes for Maori, the problems cannot begin to be solved until they are at first acknowledged.
Comments
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Posted by Noel Townshend 7:41 pm, 23 May 2011 Reply
As a 51 year old gay man from a strict Anglican farming family, there is absolutely nothing you can tell me about Homophobia.
I went to Southland Boy's High School in the 1970's. Rugby players were Gods. French, Latin and German scholars like myself were all treated as poofs, regardless of evidence one way or the other.
Caning and violence from staff and pupils alike was an everyday occurrence. Bullying and homophobic abuse of every stripe were my lot. meals. Boarding at Coldstream Hostel was a nightmare. I hated it with a purple passion, but had no say in the matter. I left to board with family just in time.
Amongst my family, I was seen as eccentric and effeminate, but that was as far as they were prepared to look. I eventually found the courage to come out at the age of 25.
I was pivotal in lobbying for law reform. I am free -
Posted by Ben 12:49 am, 19 Sep 2011 Reply
As an English gay guy, who went to a boarding schoolin the 80s, I heard a lot of homophobia - guys who were gentle were called poofters, and the guys at the school were encouraged to be like 'men' and 'macho'. I used to look at other guys in a sexual way in the shower and elsewhere!
I eventually came out 13 years ago at the age of 27. I don't remember anyone being gay at school - no doubt they kept it to themselves if there were! I was more nervous about telling my family than my friends, but they accepted it! My birth-mum didn't accept it though, as she comes from a religious background! I've only had one negative reaction here in New Zealand, but have had loads in England! -
Posted by MercuryinTN 3:38 am, 17 Mar 2012 Reply
The sad thing is, some of these studies about homosexuals and mental illness will have excerpts taken from them and they'll be used against homosexuals. The reason some homosexuals suffer from mental distress is because of society and homophobic attitudes toward us. It takes a strong individual to stand up to them and be proud of who you are. I congratulate all those who stand up to the bullies and will not allow them to push a hateful, vile agenda. If homophobes stop discriminating there would be less problems in the world.
